On Sept. 1, the Texas Health and Human Services Commission (HHSC) will begin Phase I of its Medicaid HMO expansion, converting the Medicaid Primary Care Case Management model to the Medicaid HMO model in the 28 counties contiguous to the current Medicaid HMO service delivery areas of Bexar, El Paso, Harris, Lubbock, Nueces, and Travis counties. As part of the conversion, the state also will create a new service delivery area – Jefferson -- consisting of 11 counties in Southeast Texas.

The study found that — not surprisingly — obesity rates are skyrocketing. In 2007, only one state had an obesity rate above 30 percent, but in 2011 more than 12 states, including Texas, have obesity rates above 30 percent. More than 20 percent of adolescents (ages 10-17) are considered obese.

In Texas 38.5 percent of blacks and 36 percent of Latinos are considered obese. Rich Hamburg, deputy director for Trust for America’s Health, said Texas' obesity rates are directly linked to poverty, which unfortunately correlates with race.

Hamburg said the obesity epidemic is linked to a dearth of healthy foods available for people on fixed incomes. Many live in so-called "food deserts," and are unable to get to a grocery store and purchase healthy foods. Others are not able to participate in recreational activities because their neighborhoods are unsafe.

“This has been a problem 30 years in the making,” Hamburg said, “and there is not magic bullet to solve the problem."

Obesity is not the only issue plaguing Texas: Chronic health problems like diabetes and high blood pressure have been on an upward slope. In 1995, Texas had a diabetes rate of 5.9 percent; currently the rate is 9.6 percent.

“The information in this report should spur us all – individuals and policymakers alike – to redouble our efforts to reverse this debilitating and costly epidemic,” said Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. “Changing policies is an important way to provide children and families with vital resources and opportunities to make healthier choices easier in their day-to-day lives.”

State and federal lawmakers have begun doing this, implementing school meal standards and physical education requirements. But researchers note that many of these policies are not curbing the obesity epidemic because they don't address the conditions in which families live and children play.

“Creating healthy environments is key to reversing the obesity epidemic, particularly for children,” Lavizzo-Mourey said. “When children have safe places to walk, bike and play in their communities, they’re more likely to be active and less likely to be obese. It’s the same with healthy food: When communities have access to healthy affordable foods, families eat better.”

Jul 1, 2011

It's not your imagination. Most health insurers are getting worse at correctly paying physicians' claims, the American Medical Association says in its fourth annual National Health Insurer Report Card. AMA reports that the overall rate of inaccurate claims payments increased since 2010 among major commercial health insurers, wasting billions of dollars and frustrating patients and physicians.

TMA Legislative News Hotline

Friday, July 1, 2011

Bruce Malone, MD

Message from TMA President C. Bruce Malone, MD

Our top priority as the 2011 legislative session convened was to protect the patient-physician relationship in every aspect of the health care system. With an enormous budget deficit and special interest groups from hospitals to midlevel practitioners lining up to take on medicine, it felt like everyone wanted a piece of our profession. Many of our adversaries wanted control of physicians, our practices, and our patients. Others wanted to weaken the Texas Medical Board (TMB), jeopardizing Texas’ hard-fought liability reforms and Texans’ access to care. Some believed physicians were the cost drivers and needed restraint.

However, when the session ended this week, physicians crossed the finish line with the reins still in hand. Even better, lawmakers took major steps to protect and strengthen the patient-physician relationship from future outside interference.

Working with the legislature, we were able to minimize the Medicaid cuts to office-based physicians, so that our hard-working doctors can continue to see the neediest Texas patients and continue their important work of improving the health of all Texans.

Here is a short list of TMA accomplishments:

✔ Fought off severe cuts to physicians’ Medicaid payments. Result: Physicians won’t be forced to stop seeing Medicaid patients.✔ Protected the patient-physician relationship against corporate interference.Result: Patients’ health care needs come before a corporation’s bottom line.✔ Defended clinical autonomy of physicians employed by rural hospitals, 501(a)’s, and future health care collaboratives.Result: Physicians and their patients have ultimate control of health care decisionmaking.✔ Won Texas Medical Board reforms.Result: The improved TMB disciplinary process is much fairer for physicians without endangering Texas' medical liability reforms. The anonymous complaint waseliminated.✔ No scope-of-practice expansions.Result: Midlevel practitioners and allied health professionals must stay within a scope of practice safely permitted by their education, training, and skills. The doctor is the trusted leader of the health care team.✔ Safeguarded the public health system.Result: Cuts to tobacco cessation and chronic disease prevention programs were mitigated.✔ Improved immunization requirements.Result: College students are protected from contracting meningococcal meningitis. And new vaccination policies ensure health workers won’t spread infectious diseases to their patients.